Multidisciplinary Cancer Care at KKH- Najran
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This document discusses the establishment of a multidisciplinary cancer care unit at King Khalid Hospital in Najran, Saudi Arabia. It aims to provide comprehensive cancer treatment using evidence-based guidelines. The cancer unit has several goals, including becoming a training center and establishing a cancer registry. It has developed phases to expand its services from medical and surgical oncology initially to include nuclear medicine and radiation oncology. A multidisciplinary tumor board follows guidelines to determine the best diagnostic and treatment approaches for patients. The importance of a multidisciplinary approach is emphasized to determine personalized treatment plans tailored to each patient.
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Multidisciplinary Cancer Care at KKH- Najran
- 1. Towards Multidisciplinary Cancer Care at KKH- Najran Ahmed Badheeb , MD. Professor Of Oncology & internal medicine King Khalid Hospital- Najran
- 2. Objectives • • • • Cancer : the size of the problem in Najran Cancer unit : the goals. The Tumor Board at KKH: functions & guidelines The importance of multidisciplinary approach.
- 3. Cancer in Saudi Arabia : 2004
- 4. Cancer in Saudi Arabia : by sex
- 5. Cancer in Saudi Arabia : by age
- 6. Cancer in Saudi Arabia : by ASR
- 10. There is an urgent need for Cancer registry • Saudi Cancer Registry (population based). • Hospital based registry
- 11. Objectives • Cancer : the size of the problem in Najran • Cancer unit : the goals. • The Tumor Board at KKH: functions & guidelines • The importance of multidisciplinary approach.
- 12. Goals of the oncology Service: • A comprehensive evidence based cancer (including the psycho-social care). • To be a nucleus for the upcoming cancer center. • Training Centre for the doctors, medical students, nurses ,pharmacists, social workers, etc. • Cancer registry service (both hospital based & population based). • Cancer research .
- 13. Phases of the development • Phase (I): Medical & surgical oncology (?). • Phase(II): Nuclear medicine • Phase (III): addition of radiation oncology service.
- 14. Phase : 1
- 18. VAD team
- 19. Safe handling of chemotherapy
- 20. Social support
- 21. Your diagnosis is cancer !!
- 24. Palliative care & pain management
- 25. Modified WHO Analgesic Ladder Quality of Life Invasive treatments Proposed 4 th Step Opioid Delivery Pain persisting or increasing Step 3 Opioid for moderate to severe pain ± Nonopioid ± Adjuvant Pain persisting or increasing The WHO Ladder Step 2 Opioid for mild to moderate pain ± Nonopioid ± Adjuvant Pain persisting or increasing Step 1 ± Nonopioid ± Adjuvant Pain Deer, et al., 1999
- 26. Cancer research unit • Epidemiologists • Bio- statistician
- 30. Procedure Room
- 31. KHH lab upgrade
- 33. Flowcytometry
- 34. Cytogenetics
- 35. Phase II
- 36. Phase II Bone Scan Patient A Multiple bone metastase s
- 37. Phase: III
- 38. Phase: III
- 39. Objectives • Cancer : the size of the problem in Najran • Cancer unit : the goals. • The Tumor Board at KKH: functions & guidelines • The importance of multidisciplinary approach.
- 40. Function To approve the best evidence based multidisciplinary diagnostic & therapeutic approach for tumor cases.
- 41. Multidisciplinary Tumor Board Surgical, medical & radiation oncologists, radiologists, pathologists, nuclear medicine, and coordinator nurses , social worker & psychologist specialists
- 42. Saudi cancer Guidelines NCCN • Modified from • Written by the most expert oncologists in the country in each branch.
- 43. What is the NCCN? An Alliance of 21 Academic Cancer Centers in USA
- 44. NCCN Levels of Evidence • Category 1: Based upon high-level evidence and uniform NCCN consensus that intervention is appropriate • Category 2A: Based on lower-level evidence and uniform NCCN consensus that it constitutes appropriate care • Category 2B: Based upon lower-level evidence and NCCN consensus that it constitutes appropriate care • Category 3: Any level of evidence but major NCCN disagreement that the recommendation is appropriate.
- 45. Examples from Breast Cancer Guideline
- 46. Objectives • • • • Cancer : the size of the problem in Najran Cancer unit : the goals. The Tumor Board at KKH: functions & guidelines The importance of multidisciplinary approach.
- 47. Fundamental questions When is surgery enough? Should we use chemotherapy? difficult to reverse practice Which treatment should we use? toxicity-many 'equal' therapies efficacy dosage
- 48. What is the best for the patient? Neoadjuvant ? Adjuvant ? •M astectomy vs. lumpectomy •Lymph node dissection vs. sentinel lymph node biopsy
- 49. Sentinel Lymph Node Biopsy 2. Track the lymphatic drainage of the
- 50. Personalized Oncology Ligand Ligand EGFr dimer Signal Adapters and Enzymes Grb-2 Shc SOS Grb-2 P13K MAPK = mitogen-activated protein kinase PTEN P13k = phosphatidylinositol 3-kinase SOS Ras Raf Akt MEK 1/2 Signal mTOR Transcription Factors FKHR GSK-3 Cascade BAD MAPK p27 Jun Cyclin D-1 FOS Myc
- 51. Thank you
Editor's Notes
- Proposed 4th step – looking at quality of life, changing opioid delivery, looking at invasive treatments
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